A fistulotomy is a surgical procedure used to treat afistula.
A fistula happens when two organs or tracts form an abnormal connection.
Fistulotomy is most commonly used to treat uncomplicated perianal fistulas (those occurring in and around the anus).
Verywell / Brianna Gilmartin
These typically occur when anabscessdevelops in perianal tissues and breaks through the walls of adjacent structures as it grows.
Fistulotomy can help open and drain the pocket so that the tissues can heal and kill the abnormal passage.
What Is Fistulotomy?
Fistulotomy can be performed in a healthcare provider’s office, particularly when fistulas are small and shallow.
Larger fistulas may need to be treated in a hospital operating room undergeneral anesthesia.
What’s the Difference Between a Fistulotomy and a Fistulectomy?
Fistulotomy should not be confused with a fistulectomy.
Both fistulotomy and fistulectomy are procedures to correct an anal fistula.
Fistulectomy removes the entire fistula, including some tissue surrounding it.
Contraindications
Fistulotomy is contraindicated for the treatment of complex fistulas.
For these same reasons, fistulotomy is avoided in people with recurrent fistulas or those with pre-existing fecal incontinence.
Potential Risks
As with all surgical procedures, fistulotomy poses a risk of injury and complications.
Some can occur immediately after the procedure, while others may develop within weeks or months.
These fistulas can usually be treated quickly and effectively in an in-office procedure.
This is because an additional procedure,sphincteroplasty, may be needed to rebuild the sphincter following the fistulotomy.
It is a technically complicated surgery that many surgical centers do not offer.
Fistulas should never be left untreated as they will not heal on their own.
Untreated fistulas can lead to long-term or potentially life-threatening complications, such assepsisandanal cancer.
If performed by agastroenterologist, the digital exam may be all that is needed to make the initial diagnosis.
A gastroenterologist or ageneral internistwho has undergone additional training in the gastrointestinal tract may handle less-complicated cases.
Leave any valuables at home, including watches and jewelry.
You will be asked to remove contact lenses, dentures, hearing aids, and piercings before the surgery.
Food and Drink
You should stop eating at midnight on the night before the surgery.
Within four hours, you cannot drink or eat anything, including gum or ice chips.
You will also need to bring someone with you to drive you home.
The anesthesiologist should also advise you about which pop in of anesthesia is being used and why.
This will be pushed through your IV.
In such cases, an anesthesiologist may not be necessary.
Pre-operativeantibioticswill be delivered through the IV line to aid with healing and help prevent infection.
An anal retractor gently opens the anus while the fistula itself is cut with a scalpel.
Every effort will be made to avoid or limit damage to the anal sphincters.
Once open, the base of the wound iscuretted(scraped).
The wound is then left open to heal on its own.
Finally, the wound is either packed or covered with gauze and bandaged to help keep it clean.
Food and drink may be given, as well asanti-nausea medicationif you feel nauseous.
After that, the dressing can usually be changed daily.
It is important to note that, even with proper care, complications of fistula surgery can sometimes occur.
To help ease pain during bowel movements, eat afiber-rich dietand use alaxative or stool softeneryour surgeon prescribes.
Many people wonder how to wipe after a fistulotomy.
Avoid using terrycloth towels or sponges to clean the wound.
After washing, pat rather than rub the skin dry.
Fifteen-minute sitz baths can also help.
Long-Term Care
Fistulotomy is highly effective in resolving simple perianal fistulas.
If the fistula heals without complications, it usually won’t return or require ongoing medical care.
2022;8(4):e336-e340.
2015 Jul;19(7):391-400. doi:10.1007/s10151-015-1323-4
Cedars Sinai Medical Center.Fistulas.
2019;9(10):e029913.
2019;11(3):e4200.
